This is the second part of the article about Grief and Bereavement Counselling Models from Neil Morrison. This article was published in the Institute of Counselling’s journal ‘The Living Document’ Spring 2010 edition. Please enjoy.

Murray Parkes moved from stages to phases and cycles, which were fluid in their construction. He worked with Bowlby (l6), the father of attachment theory, and so began to understand the dynamics of attachment and separation and the pain that this dynamic caused. Dr. Parkes presented a lecture to Cruse Bereavement Care (17) which included the following powerpoint slide:

ATTACHMENT THEORY

(John Bowlby)

All social animals become attached to each other.

The main function of attachment is to provide security.

The function of crying and searching following separation is to provide reunion.

The nuclear source of security is the family.

The above illustration of social attachment shows how security, reunion and the family are all impacted by death and bereavement. That is, “the ideas that Colin Murray Parkes shared together go beyond description to propose an explanation, rooted in attachment theory, for the nature of complicated responses to bereavement. The thinking expounded here is destined to become part of the accepted fabric of those working in this field and will undoubtedly prompt continuing debate and further research.” The key word here is complicated – no matter whether it is ‘stages’, ‘cycles’ or ‘tasks’ of grieving and mourning.

Stages of Grief –

A Cyclical Model (ColinMurray Parkes)

By describing different stages, Murray Parkes (18) implied that grief was a journey. It has various landmarks and the route will meander and change direction along the way. The final destination or end point of the journey is the healthy resolution of the loss.

Four stages are identified. These include:

1. Shock versus Reality –

– Characterised by numbness, denial and a sense of unreality.

2. Protest versus Experience

– Characterised by yearning and longing for what is lost.

3. Disorganization versus Adjustment

– Slowly realizing the full impact of the loss and finding a way of coming to terms with the changes death precipitates.

4. Attachment versus Reorganization

– Accepting that life has changed forever. Reattaching and forming new relationships. Establishing a new and fulfilling life separate from the deceased.

Colin Murray Parkes emphasized that these stages manifested in cycles which could reoccur during the grief journey.

William Worden – The Tasks of Mourning

William Worden (19) introduced the ‘Tasks of Mourning’. This not only observed what happened to grieving clients but was also proactive in that it suggested ‘tasks’ that clients could work through in order to facilitate the grieving experience. These are summarised below:

Task 1: To Accept the Reality of the Loss.

Task 2: To Work Through the Pain of Grief.

Task 3: To Adjust to the Environment in Which the Deceased is Missing.

Task 4: To Emotionally Relocate the Deceased and Move on With Life.

When a grieving client cannot work through each task successfully, they may experience complicated mourning.

This can be described as follows:

Task 1 not tackled: This is where the person does not acknowledge the reality of the loss.

Task 2 not tackled: This is where the person has not allowed himself or herself to experience the pain of grief.

Task 3 not tackled: This is where the bereaved person is unable to adjust to living without the person who has died.

Task 4 not tackled: This is where the person is unable to move on and does not, therefore, have the energy to adjust to the environment without the deceased(20),(21)Worden’s Task 4 has received some criticism, as is highlighted by the following quote from a University paper on ‘Holding on and letting go: The resolution of grief in relation to two Xhosarituals in South Africa’:

“While the dominant emphasis in contemporary bereavement literature is on the need for the bereaved to sever their ties with the deceased, this is not a straightforward issue … (It is possible that) some ties are not easily severed. Maintaining the polarity between the ‘holding on’ versus ‘letting go’ distinction is thus not always helpful, as this ignores the references within contemporary literature to holding on and disregards a multiplicity of meanings of what holding on and letting go entails”.

Worden himself has moved on from ‘letting go’ to ‘relocating’ the deceased in the mind of the bereaved. This is viewed as being a more humane way of counselling the person.

This is an article about Grief and Bereavement Counselling Models from Neil Morrison. This article was originally published in The Living Document Spring 2010. I hope you enjoy.

GRIEF AND BEREAVEMENT COUNSELLING MODELS

By Neil Morrison

Introduction

Historically, counsellors will look to the work of Dr Elisabeth Kubler-Ross (13) the pioneer of support to personal trauma, grief and grieving, associated with death and dying. Her work dramatically improved the understanding and practices in relation to bereavement and hospice care.

Kubler-Ross’ ideas, notably the Five Stages of Grief Model (denial, anger, bargaining, depression, acceptance), are also transferable to personal change and emotional upset resulting from factors other than death and dying.

Dr. Kubler-Ross was at pains to stop practitioners thinking of her Five Stages of Grief Model as linear. However, it seems that this has been the thinking of many practitioners. (Worden (14), Parkes (15)). A common criticism was that not all clients come to the acceptance stage and may seem to be ‘stuck’ in the grieving experience at anger or depression. That was certainly my experience whilst in clinical training as a hospital chaplain. Many patients were stuck in their grieving experience and acceptance was by no means universal.

The concept that people in bereavement go through a grieving process is now also being challenged.

Is there a universal grieving process?

What seems to be developing is the view that people go through a grieving experience which is different for different people. This would, then, suggest that the Stages of Grief model is somewhat out of date.

Other theorists, while accepting the value of Dr. Kubler-Ross’ work, have moved on to phases and cycles, rather than stages, of the grieving experience (for example, Worden, Parkes and Ainsworth-Smith).

Russell Friedman and John W. James of The Grief Recovery Institute state: “We hesitate to name stages for grief. It is our experience that given ideas on how to respond, grievers will cater their feelings to the ideas presented to them. After all, a griever is often in a very suggestible condition: dazed, numb, walking in quicksand. It is often suggested to grievers that they are in denial. In all of our years of experience, working with tens of thousands of grievers, we have rarely met anyone in denial that a loss has occurred.

This is the first of two parts of Alana Fraser’s article Alcohol Abuse And Domestic Violence. This article was published originally in The Living Document edition Summer 2011. Please enjoy. The second part of this article will be posted soon.

ALCOHOL ABUSE AND DOMESTIC VIOLENCE

Introduction

Domestic violence is widespread today in Western society. There are many factors that contribute to abuse: one common influence being alcohol consumption. In a culture of high stress and increasing pressure, it is perhaps not surprising that many individuals turn to alcohol to alleviate the strain and the negative feelings they are struggling with. However, their decision to engage in substance abuse not only affects the person themselves, but it affects the people around them as well

Sadly, children are often the most vulnerable-and at the greatest risk- in these abusive situations. Also, observing or experiencing abuse as a child can lead to emotional and developmental issues. These can continue into adulthood.

Although there is no clear causal relationship between alcohol consumption and domestic violence, often alcohol abuse is also reported in cases of spousal or child abuse. Furthermore, when the two co-exist, research indicates there is an increased frequency of domestic violence and an increased severity of injuries inflicted(1).

In terms of treatment, if the person can be helped to identify the relationship between their alcohol dependency and their violent behaviour, then counselling is shown to be more effective.

However, if the person does not understand the relationship between the two, they will have difficulties in controlling their negative and abusive behaviour.

Where Does the Responsibility Lie?

Substance abuse (including alcohol dependency) can lead to reactions that are out of character. For example, being under the influence of alcohol impairs one’s judgement, which can lead to harmful or negative behaviours. Also, an intoxicated person may find it hard to think through the consequences of their actions. However, although many may feel as if they have lost control and are not their true selves when intoxicated – this is not an excuse for abusive behaviour. This is summed up well in the following statement:

“From a cultural perspective, focusing on a perpetrator’s alcohol use can be criticized as permitting men to excuse their behaviour as driven by drink, thus providing a means of avoiding personal responsibility.”(2)

That is, instead of taking responsibility for one’s choices and actions, the responsibility for poor behaviour is being transferred from the person to the alcohol. Clearly, this type of attitude towards substance abuse is detrimental and erroneous. It is a kind of deception which allows the person to think that their behaviour is acceptable- regardless of the impact that it has on other people.

Effects on Thinking and Behaviour

Overconsumption of alcohol leads to an altered state of consciousness which, in turn, affects cognition and decision making skills:

“Research has shown that alcohol consumption affects our cognitive or thinking abilities. Types of cognitive abilities include, but are not limited to, attention, concentration, problem solving skills, and the ability to consider the consequences of our actions.”(3)

That is, alcohol consumption affects the way one thinks and reacts to situations and other people. For example, when a person is under the influence of alcohol they are less likely to think about consequences and may react spontaneously out of emotion.

In other situations, drunkenness can result in a feeling of excessive confidence or a boldness that translates to aggressive behaviours. This is why it is more common for domestic violence to occur when alcohol has been consumed.

A fight may start and, when the argument gets heated, the intoxicated spouse might overreact and hit out in frustration, anger or rage.

This is because they are responding from their feelings and are battling a sense of loss of control. The following statement illustrates this point:

“Individuals who consume alcohol respond to provocation with more aggression than do individuals who have not consumed alcohol.”(4)

From this, we may conclude that an intoxicated person, who feels provoked by their spouse or children, is more likely to respond in a violent way than a person who is sober and has greater self-control.

I would like to share an article with you today, the article is an excerpt taken from the Institute of Counselling’s Journal ‘The Living Document’.

This article was written by a former student of the Institute of Counselling.

The article details the students reflections and thoughts on studying counselling skills and how the process has enriched her understanding of her personal life.

I hope you enjoy.

A STUDENT’S REFLECTION ON STUDYING COUNSELLING SKILLS

This article traces my progress through my studies with the Institute of Counselling. However it does not primarily focus on what I have learned, the knowledge I have gained and the skills I have acquired. Rather, it discusses the challenges I have faced, and it charts how my experiences have informed my learning, and conversely how my learning has enriched my understanding of my own personal life.

I am a staff nurse working in a unit for people with severe dementia. In the words of our psychiatrist, it is essentially “a hospice for people with dementia”. It is where clients are referred when all other care options have been exhausted. Thus, I frequently provide end of life care. This was one of the reasons I decided to explore a course in grief and loss.

While researching this, I stumbled across the Institute of Counselling’s Graduate Diploma in Counselling Skills. I chose this course for a number of reasons …

First, it offered a module in Grief and Loss Counselling; second, it provided training at a higher level than my undergraduate degree; third, I have always had an interest in, and hoped to study counselling; and fourth, it included an element of pastoral counselling. This was important to me, as I am a practising Christian.

I commenced my studies in 2008.

During my first year, I studied two modules:

Foundation in Counselling Skills, and Grief and Bereavement Counselling Skills. On commencing the first module, I quickly realised that the essential qualities of Carl Rogers’[1] and Gerard Egan’s[2] approaches are those that underpin all elements of my nursing practice. These are genuineness, warmth and empathy. In fact, these qualities are the building blocks for all my relationships in life – both at work, and with my friends and family.

The second module focused on Grief and Bereavement Counselling Skills. Although the focus was on helping those who’ve lost a loved one, I found myself thinking more about how best to support families who were trying to make sense of this devastating illness, and the impact it was having on their lives. Indeed, many families grieve the loss of “the person they once knew” as dementia changes “the person they now are”.

I can identify with this sense of loss as my own much-loved grandma had dementia for five years. During that time, I witnessed her change from being a vibrant lady who loved to sing and dance to being a mere shadow of her former self, where she depended on others to meet her every need.

For example, when supporting loved ones I frequently find that the problems they present me with are not the core issues. This model helped me to explore and identify ‘what was really going on’ beneath the surface.

A case which illustrates this is a lady who was finding it hard to come to terms with her husband’s illness, and move him into long term care. By applying Egan’s model we were able to uncover that the key issue for her was actually guilt. Specifically, guilt that she had let her husband down, guilt that she had failed in her role as wife, and guilt that she could no longer cope with caring for her husband. Over time, she was able to work through these issues, using different counselling techniques and tools.

For example, we used Force-field Analysis to help the wife decide whether it was better for her to care for her husband at home or whether long term care would be more appropriate. This also helped her deal with her negative guilt feelings.

During my second year, I began to study Couple and Family Counselling Skills. This was a challenging module for me as both of my parents are alcoholics, and as a child I witnessed and experienced things that no child should see or experience.

Thus, studying the material highlighted my own need to address buried issues that I still needed to work through in an honest and open way. This was often very difficult for me. From a professional perspective, this experience showed me how important it is for a counsellor to work through issues that could interfere with the counselling process and relationship. That can help alleviate the likelihood of transference and counter- transference occurring.

When I started on this second module, I didn’t realise how useful it would be to my work as a nurse. I had viewed studying families as a means to an end: it was simply a module I had to complete to fulfil the requirements of my graduate diploma.

Although I frequently worked with my patients’ families, developing family and couple counselling skills seemed largely irrelevant to my job. However, I soon realised that my assumptions had been wrong, as studying a Family Systems Approach helped me better understand the dynamics within the family unit. This was reinforced by my research for an essay which detailed the benefits of using Systems Theory in the field of palliative care.

Studying this module proved to be challenging in other – unrelated- ways as well.

I suffer from severe asthma which is usually kept under reasonable control. However, during this time it became more problematic. I also developed polyarthalgia which was difficult to treat because of my asthma. In addition to this, I am a carer for a close friend. As her health deteriorated significantly, this increased the demands on me.

Although this was proving to be a very tough year, my module leader, Neil, was able to support me, so I managed to make it, and complete the work.

At present, I am working on the final module: Crisis and Trauma Counselling Skills. I have always found this area interesting. I am also aware that people facing crises have acute and serious needs.

In terms of my personal situation, shortly after commencing with my third year module I was admitted to hospital because of my asthma. There, my consultant gently shared that there was nothing more medicine could offer me. This was devastating news as I had always held out hope – but now that hope was gone. I returned home left to deal, in whatever way I could, with the impact that this news had had on me.

My consultant is excellent; however, I felt let down as there was a complete lack of emotional support in dealing with the news. I know my experience is not unique, and I really feel that counselling could offer a lot to people who are coping with a long term illness. Although the health service can offer us partial support, there is definitely a lack of holistic care.

On top of these concerns, a good friend passed away while I was preparing my first essay for the module. I felt heartbroken as the loss was sudden-yet many failed to understand the very real impact it had on me. To be honest, in some ways it felt silly as my friend was not a person: it was my guinea pig, Prince Harry. I had adopted this lad from a rescue centre. He was in terrible condition when I took him home – but he had thrived and blossomed into a cheeky little character. Hence, I was very attached to my pet. What made this so hard, even though he was in pain, was the guilt I experienced over ending his .

The death of a much- loved pet is frequently underestimated and dismissed by many. As I prepared this article I spoke to several people who had lost their pets. All described it as a devastating experience, and one person likened it to ‘the loss of a limb’. Many described the same emotions as those associated with the loss of a human friend. However, they sensed few people understood how they felt, dismissing their grief as an overreaction. This is something that counsellors should note as often a strong bond of trust and love exists between a much loved pet and its owner. Hence, the loss of a pet can be devastating.

I am almost at the end of my studies now, and I can look back and say I have enjoyed it immensely. It has presented me with many intellectual challenges and life has added its own as well. It has certainly been hard work and has required me to juggle and prioritise my time and responsibilities. However, I have developed my skills and increased my knowledge.

I also believe I have grown as a person, and become much more confident. I am now considering my future options as I would like to move into an area of work that is less demanding physically. That would accommodate my health issues-but also allow me to use my skills and knowledge to help other people in a meaningful way.

When I complete this course, I will embark on the Diploma in Youth Counselling. This should help me in my volunteer position as the children’s advocate in my church. I am sure this new course will bring further challenges, as well as new opportunities for developing my knowledge, skills and qualities as an individual and a counsellor.

This is an article about Alcoholics Anonymous A.A., which was published in the Institute of Counselling’s Journal ‘The Living Document’.

I hope you enjoy.

ALCOHOLICS ANONYMOUS AT A GLANCE

Most individuals have heard of A.A. It is committed to supporting recovering alcoholics.

In the following article we provide some information on A.A.: its policies, its principles, its practices and key philosophy.

What is Alcoholics Anonymous?

Alcoholics Anonymous (A.A.) is a voluntary, world-wide fellowship of men and women from all walks of life, who meet together to attain and maintain sobriety. The only requirement for membership is a desire to stop drinking. There are no fees for A.A. membership.

A.A. members say that they are alcoholics today, even when they have not had a drink for many years. They do not say that they are ‘cured’. Instead, A.A. members believe that once people have lost their ability to control their drinking, they can never be sure of drinking safely again. That is, they can never become ‘former alcoholics’ or ‘ex-alcoholics’. However, they can become sober or recovered alcoholics.

How A.A. Members Maintain Sobriety

Alcoholics Anonymous is a programme of total abstinence where members stay away from one drink, one day at a time.

Sobriety is maintained through (i) sharing experience, strength and hope at group meetings and (ii) by working through The Twelve Steps of A.A.

These steps are summarised as follows:

We admitted we were powerless over alcohol – that our lives had become unmanageable.

We came to believe that a Power greater than our-selves could restore us to sanity.

We made a decision to turn our will and our lives over to the care of God, as we understood Him.

We made a searching and fearless moral inventory of ourselves.

We admitted to God, to ourselves and to another human being the exact nature of our wrongs.

We were entirely ready to have God remove all our defects of character.

We humbly asked Him to remove our shortcomings.

We made a list of all persons we had harmed and became willing to make amends to them all.

We made direct amends to such people wherever possible, except when to do so would injure them or others.

We continued to take personal inventory and when we were wrong, promptly admitted it.

We sought through prayer and meditation to improve our conscious contact with God – as we understood Him – praying only for knowledge of His will for us, and the power to carry that out.

Having had a spiritual awakening as the result of these steps, we tried to carry this message to alcoholics, and to practise these principles in all our affairs.

Who can Attend A.A. Meetings?

There are two types of A.A. meetings: (i) open meetings and (ii) closed meetings

Anyone may attend open meetings. Here, speakers tell of how they drank, how they discovered A.A. and how the programme has helped them personally.

Closed meetings are for alcoholics only. These are group discussions where any members can share, ask questions or offer suggestions to their fellow members.

Current Membership

It is estimated that, at present, there are more than 114,000 A.A. groups and over 2,000,000 members in 180 countries.

This is an article about Alcoholics Anonymous A.A., which was published in the Institute of Counselling’s Journal ‘The Living Document’.

I hope you enjoy.

ALCOHOLICS ANONYMOUS AT A GLANCE

Most individuals have heard of A.A. It is committed to supporting recovering alcoholics.

In the following article we provide some information on A.A.: its policies, its principles, its practices and key philosophy.

What is Alcoholics Anonymous?

Alcoholics Anonymous (A.A.) is a voluntary, world-wide fellowship of men and women from all walks of life, who meet together to attain and maintain sobriety. The only requirement for membership is a desire to stop drinking. There are no fees for A.A. membership.

A.A. members say that they are alcoholics today, even when they have not had a drink for many years. They do not say that they are ‘cured’. Instead, A.A. members believe that once people have lost their ability to control their drinking, they can never be sure of drinking safely again. That is, they can never become ‘former alcoholics’ or ‘ex-alcoholics’. However, they can become sober or recovered alcoholics.

How A.A. Members Maintain Sobriety

Alcoholics Anonymous is a programme of total abstinence where members stay away from one drink, one day at a time.

Sobriety is maintained through (i) sharing experience, strength and hope at group meetings and (ii) by working through The Twelve Steps of A.A.

These steps are summarised as follows:

We admitted we were powerless over alcohol – that our lives had become unmanageable.

We came to believe that a Power greater than our-selves could restore us to sanity.

We made a decision to turn our will and our lives over to the care of God, as we understood Him.

We made a searching and fearless moral inventory of ourselves.

We admitted to God, to ourselves and to another human being the exact nature of our wrongs.

We were entirely ready to have God remove all our defects of character.

We humbly asked Him to remove our shortcomings.

We made a list of all persons we had harmed and became willing to make amends to them all.

We made direct amends to such people wherever possible, except when to do so would injure them or others.

We continued to take personal inventory and when we were wrong, promptly admitted it.

We sought through prayer and meditation to improve our conscious contact with God – as we understood Him – praying only for knowledge of His will for us, and the power to carry that out.

Having had a spiritual awakening as the result of these steps, we tried to carry this message to alcoholics, and to practise these principles in all our affairs.

Who can Attend A.A. Meetings?

There are two types of A.A. meetings: (i) open meetings and (ii) closed meetings

Anyone may attend open meetings. Here, speakers tell of how they drank, how they discovered A.A. and how the programme has helped them personally.

Closed meetings are for alcoholics only. These are group discussions where any members can share, ask questions or offer suggestions to their fellow members.

Current Membership

It is estimated that, at present, there are more than 114,000 A.A. groups and over 2,000,000 members in 180 countries.

This is the article ‘A beautiful mind’, followed by two poems from the ‘Poet’s Corner’, published in ‘The Living Document’ edition Autumn 2010.

Enjoy folks.

A BEAUTIFUL MIND

We’re all susceptible to mental health concerns. This is certainly true as we approach the twilight years. But there are steps that we can take to minimise the risks and to keep on living a full and healthy life.

Here are ten ideas to keep your mind alert.

Maintain an active lifestyle: Include stretching and walking in each day’s routine; take the stairs – not the lift; cut the grass and prune the shrubs.

Eat a balance diet We all know the benefits of eating more raw foods and cutting back on fatty and sugary snacks.

Exercise your mind: Sudukos, crossword puzzles, word searches and card games have all been shown to shake up those grey cells. Learning something different – a language or a skill – will also keep the mind agile and alert.

Spend time with other people: Make sure you make the effort to catch up with your friends and to call or to visit people in your family. Making new friends is highly rewarding as well.

5. Don’t forget to schedule annual checkups with your doctor: Prevention and early detection of health issues can add many quality years to your life.

Be a volunteer: The more we give out, the more we get back. There are mental and physical benefits to this.

Don’t worry; be happy: A positive attitude is linked to good health – and to happy, fulfilling relationships as well. Forgive and forget… and live each day to the full.

Think about buying, and caring for, a pet: Pets can fill the days and hours with companionship and warmth. They’re usually fun to have around and are a source of endless joy.

Fill your life with laughter: Laughter relieves worry and blows the blues the away. It helps us get life in perspective and renews our sense of fun.

Don’t be tooproud, or afraid, to ask for help: We all need support and a helping hand at times.

POET’S CORNER

BEAUTIFUL OLD AGE

By D.H. Lawrence

It ought to be lovely to be old

to be full of the peace that comes of experience

and wrinkled ripe fulfilment.

The wrinkled smile of completeness

that follows a life lived undaunted and unsoured with accepted lies

they would ripen like apples, and be scented like pippins

in their old age.

Soothing, old people should be, like apples when one is tired of love.

Fragrant like yellowing leaves,

and dim with the soft stillness and satisfaction of autumn.

And a girl should say:

It must be wonderful to live and grow old.

Look at my mother, how rich and still she is! –

And a young man should think: By Jove

my father has faced all weathers, but it’s been a life!

AFTERSHOCK

By Kirsten Bale

The pendulum sways

The piano still plays,

Yet my heart can’t help but break

And my head begins to ache.

The message floats in bold

Of his body growing cold

Lying doomed now to decay

While the sky wears it’s best grey

All the warmth I’d grown to know

Lies frozen deep below

A flaming love snuffed out

Leaving anguish, pain and doubt

The sun has not ceased to shine.

But its radiance is lost in time,

The world, like a stream, moves on,

While my world and my future are gone.

I hope you found this article and the two poem’s of value.

If you have any questions then remember you can leave these in the comments below, I can also answer any questions you have.